Guidelines for Funding

Families

212 Henry St, Victoria, BC, V9A 3H9 CANADA Tel 250-475-1223 • Toll free 1-877-777-7675

Fax 250-475-1193 • www.davidfosterfoundation.com

M Make a Personal Donation

Title (e.g. Mr, Mrs, Dr): _____ First Name: _____________________

Last Name: __________________________________________

M Make Donation on behalf of an organization

Organization: ________________________________________

Address: ____________________________________________

City/Town: __________________________________________

Prov/State: _____________ Postal/Zip Code: ______________

Country: ___________ Tel: ( ____ ) ____________ Ext _____

E-mail Address:_______________________________________

M I give permission for the David Foster Foundation to contact me via e-mail with information about how I can support children receiving life saving organ transplants.

Amount: $ ________________ Currency: ________________

M 1 Time Credit Card Payment M Recurring Monthly Payment

Credit Card Type: M VISA M MC M AMEX

Credit Card #: ________________________________________

Card Security #: ___________ Expiry Date (MM/YY): ________

Card Holder’s Name: ___________________________________

I would like to make a donation in memory/honour of:

___________________________________________________

M Please notify the next of kin that a donation has been made.

M I would like to keep my gift private.

The David Foster Foundation relies on private funding to help families of children receiving life-saving organ transplants in Canada. Please make a donation today. Thank you for supporting children and their families receiving life-saving organ transplants. Donations can be mailed to: David Foster Foundation, 212 Henry Street, Victoria, BC V9A 3H9 CANADA

Canadian Charitable Business No. 10700 4210 RR0001. US Federal ID No. 81-0581479. Tax receipts will be issued upon receipt of donation. Donations can also be made online at www.davidfosterfoundation.com

DONATION FORM

Standard Types of Financial Support Provided

The David Foster Foundation provides financial support for non-medical expenses incurred by

eligible families of children needing life-saving organ transplants in Canada. The Foundation provides different levels of support for families depending on both their financial circumstances and also on what part of the transplant journey they are on. Decisions regarding support are made in consultation with the family’s social worker and transplant team. Funding is granted to pre-transplant children and their families during assessment and when a child is listed for transplant.

Most families require more support when they are waiting for a transplant and immediately following transplant. Once they are past the first year anniversary of the transplant, often support is no longer required or is reduced to assistance getting to regular medical checkups.

The Foundation does not provide financial support for medical expenses, such as prescription medications, procedures, medical care givers or equipment.

Although decisions about funding are made on a case-by-case basis based on each family’s situation and in consultation with the family’s transplant team, the following are examples of the types of non-medical expenses we provide assistance with during the waiting period and first year after transplant phases:

• Food, gas, parking, telephone bills, living expenses, items such as clothing, toiletries etc. if the family has had to relocate or leave home suddenly for their transplant in another city.

• Flights to and from medical appointments or for transplant (Westjet is a proud sponsor of the David Foster Foundation and all flights are arranged through the Foundation office).

• Flights for immediate family members to visit the transplant recipient during the waiting period and immediately following transplant including parents or siblings. If siblings traveling are underage, they

may be accompanied by one other adult if not by the parent.

• Hotel or other accommodations (such as Ronald McDonald House, Easter Seal house or other) in transplant centre (eg. Toronto, Edmonton, Vancouver, etc).

• Rental or mortgage support (for the family home) when they are away from their home or unable to work due to their child’s medical circumstances or awaiting transplant.

• Damage deposits can be funded by the Foundation but must be returned to the Foundation upon vacancy of the accommodation.

• Childcare support for other siblings if required.

After The One Year Transplant Anniversary

Family support after the first year anniversary is judged on a case-by-case basis, however for most families, support is no longer required after this time. If support is required for an annual medical checkup, financial support is limited to travel and accommodation costs for one parent and the child.

Applying For Funding

In order to receive funding, families must fill out an application form and provide a copy of the first two pages of each parents most recent Canada Revenue tax assessment notice. This must be completed and approved before funding can proceed, reimbursement for expenses incurred outside of the application process will not be considered. Application forms are available under the family resources section of our website www.davidfosterfoundation.com or through a transplant centre social worker. Parents/legal guardians must provide current tax information on an annual basis to the foundation in order to remain eligible for funding. The form should be filled out in consultation with the transplant center’s social worker who can then apply to the Foundation on the family’s behalf.

Providing Receipts

It is very important to keep track of all the purchases made with the funding you receive. Legible copies of your receipts must be sent in on a regular and timely basis, accompanied by a completed David Foster Foundation expense report. Only itemized receipts will be accepted unless otherwise arranged with the DFF office. DFF Expense reports are available on the Family Resources section of the Foundation website. This is a Canada Revenue Agency requirement.

If families do not provide receipts, the money they receive from the Foundation cannot be considered a charitable expense and the Canada Revenue agency could consider the funds provided to them to be additional income and a taxable benefit.

Expenses should be completed monthly. Expense reports and receipts should be mailed to:

The David Foster Foundation, Family Expenses 212 Henry Street, Victoria BC V9A 3H9

Or legible copies can be faxed through to 250-475-1193.

What About Emergencies?

We understand that unexpected circumstances arise – specifically medical emergencies related to transplant.

For families that are already registered with the Foundation and the information at the Foundation is up-to-date and accurate, please contact the emergency number 250-893-0424 as soon as possible, because this is the best way for the Foundation to help you with travel arrangements.

For families that are not already registered with the Foundation, communication with a social worker at your transplant centre is critical to receiving help from the Foundation.

The David Foster Foundation is committed to helping families of children needing major organ transplants according to our mandate. If you have any questions, please talk to your transplant centre social worker as soon as possible.